Trigeminal Neuropathy / Neuralgia is an extremely painful and distressing disorder that is often extremely resistant to treatment. Many patient find that a
Sphenopalatine Ganglion Block can turn off this nerve pain. It is not universally effective.
Sphenopalatine (SPG) blocks can done by transnasal catheter (Sphenocath, Allevio and TX360), It can be injected intra-orally and from facial approach often guided approach. The problem with this approach is it may only give temporary relief. Neurologists are frequently doing a series of 10 SPG Blocks to provide longer acting relief and possible permanent relief and or cure for trigeminal neuropathy and neuralgia.
A far better approach is the utilization of Self-Administered Sphenopalatine Ganglion Blocks. Self-Administered SPG Blocks are relatively easy procedure that the patient can learn and utilized on a regular basis to address these Trigeminal Disorders. SPG Blocks typically utilize 2% lidocaine with excellent responses. Life Changing results. A Suprazygomatic approach to the Sphenopalatine Ganglion can be utilized to “Jump Start” treatment but is rarely necessary long term.
Patient control of their pain by self-administration is key to improving the quality of life reducing expensive visits to physicians and emergency rooms.
The Sphenopalatine Ganglion is the largest Parasympathetic Ganglion of the head and also has Sympathetic fibers from the Superior Sympathetic Chain that pass thru the SPG. This amazing block has a 100 year safety record and relieves or improves dramatically a wide variety of disorders including headaches, migraines, cluster headaches, anxiety, fibromyalgia, depression and multiple types of ear, eye, nose and sinus issues.. This site has multiple blog posts on all types of disorders that the SPG Block is utilized to treat backed by the original scientific articles or abstracts.
Patients typically do the blocks with Cotton-Tipped Catheters and Lidocaine. The cost per block after initial appointment is less than $1.00 versus thousands of dollars for less effective neurology approach. These neurolgy costs have prompted insurance companies to dany this amazing procedure.
Long term relief by Neurolysis is described in the “The effectiveness of neurolytic block of sphenopalatine ganglion using zygomatic approach for the management of trigeminal neuropathy” (abstract below). I strongly discourage neurolysis as a first line approach. If repetitive blocking is effective it frequently gives long term relief over time. Neurolysis is a far more aggressive approach.
IMPORTANT! Many patients with “Trigeminal Neuropathy of Trigeminal Neuralgia can find relief with ULF-TENS and a Diagnostic Neuromuscular Orthotic which is also frequently effective for all kind headaches and migraines. The Trigeminal Nerve is often referred to as the Dentist’s nerve and dentists are the experts on blocking trigeminal nerves on a daily basis. Below is an abstract of a patient with Hemicrania continua misdiagnosed as Trigemininal neuralgia treated with Indomethacin. SPG Blocks are used in patients with Hemicrania continua resistant to Indomethacin treatment.
The use of neurostimulation of the trigeminal and sphenopalatine ganglion can be very effective in treating severe orofacial pain, trigeminal pain and trigeminal neuralgia. The stimulation in this article is with implanted electrodes but the Myomonito utilized in Neuromuscular Dentistry has over a 50 year safety record on stimulation or Trigeminal Nerves, Facial Nerves and the Autonomic sympathetic and parasympathetic fibers of the Sphenopalatine Ganglion.
THE MYOMONITOR CAN BE A NON-INVASIVE OR MINIMALLY INVASIVE APPROACH TO TRIGEMINAL NEUROPATHY AND TRIGEMINAL NEURALGIA AND ASSOCIATED PAINS. WHEN EFFECTIVE A DIAGNOSTIC NEUROMUSCULAR ORTHOTIC CAN BE USED TO EVALUATE A FUNCTIONAL PHYSIOLOGICAL APPROACH TO TREATMENT.
This article “Peripheral neuromodulation for the treatment of refractory trigeminal neuralgia” (abstract below) discusses .Periipheral Neuromodulation which is exactly what is done with ULF_TENS and Myomonitor stimulation.
During consultations at my office to learn Self-Administration of SPG Blocks it is usually possible to eliminate most pain by using Travell Spray and Stretch to deactivate Myofascial Trigger Points. There are excellent functional approaches to treating trigeminal pain that should be considered prior to Neurolysis.
This article, “Peripheral neuromodulation for the treatment of refractory trigeminal neuralgia” is another example of treating Trigememinal Neuralgia with Peripheral (SAFE) Neuromodulation. The Myhomonitor ULF TENS will affect these same nerves. A small portable unit of the Myomonitor is commercially available for home use.
This article, “Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: an effective treatment for trigeminal neuralgia and atypical facial pain” also emphasizes safety and efficacy of Sphenopalatine Ganglion Blocks for treating Trigeminal Neuralgia and facial pain.
Visit www.ThinkBetterLife.cog to learn about neuromuscular approach to improving your quality of life.
This link is to patient testimonials for self-administered SPG Blocks: https://www.youtube.com/playlist?list=PL5ERlVdJLdtllxAN1QwD7JU7Qo_ISoqvt
There are over 150 testimonials including SPG Blocks here: https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos
The effectiveness of neurolytic block of sphenopalatine ganglion using zygomatic approach for the management of trigeminal neuropathy.
This study was performed to present the outcomes of trigeminal neuropathy management with the application of neurolytic block of sphenopalatine ganglion. This type of procedure is used in cases where pain is not well controlled with medical treatment. Twenty patients were treated with sphenopalatine ganglion neurolysis after their response to pharmacological management was not satisfactory. Significant pain relief was experienced by all but one patient and they were able to reduce or stop their pain medication. The time of pain relief was between a few months and 9 years during the study period. Number of procedures implemented varied as some of the patients have been under the care of our Pain Clinic for as long as 18 years, satisfied with this type of management and willing to have the procedure repeated if necessary. It appears that neurolytic block of sphenopalatine ganglion is effective enough and may be an option worth further consideration in battling the pain associated with trigeminal neuropathy.
Neurolytic block; Neuropathic pain; Sphenopalatine ganglion; Trigeminal neuropathy
The Exacerbation of Hemicrania Continua Mimics Trigeminal Neuralgia.
We report the case of a 46-year-old man with hemicrania continua presenting as exacerbations mimicking trigeminal neuralgia. The patient was tentatively diagnosed with trigeminal neuralgia, and treatment with various combinations of drugs was performed after the onset of pain. However, when the condition of the patient did not improve, we suspected hemicrania continua, and treatment with indomethacin was initiated. There was a marked alleviation of his pain within 24 hours. Thus, clinicians should be aware that the duration and frequency of exacerbations of hemicrania continua are variable.
indomethacin; tooth extraction; trigeminal autonomic cephalalgias
Trigeminal and sphenopalatine ganglion stimulation for intractable craniofacial pain–case series and literature review.
Facial pain is often debilitating and can be characterized by a sharp, stabbing, burning, aching, and dysesthetic sensation. Specifically, trigeminal neuropathic pain (TNP), anesthesia dolorosa, and persistent idiopathic facial pain (PIFP) are difficult diseases to treat, can be quite debilitating and an effective, enduring treatment remains elusive.
We retrospectively reviewed our early experience with stimulation involving the trigeminal and sphenopalatine ganglion stimulation for TNP, anesthesia dolorosa, and PIFP between 2010-2014 to assess the feasibility of implanting at these ganglionic sites. Seven patients received either trigeminal and/or sphenopalatine ganglion stimulation with or without peripheral nerve stimulation, having failed multiple alternative modalities of treatment. The treatments were tailored on the physical location of pain to ensure regional coverage with the stimulation.
Fluoroscopy or frameless stereotaxy was utilized to place the sphenopalatine and/or trigeminalganglion stimulator. All patients were initially trialed before implantation. Trial leads implanted in the pterygopalatine fossa near the sphenopalatine ganglion were implanted via transpterygoid (lateral-medial, infrazygomatic) approach. Trial leads were implanted in the trigeminal ganglion via percutaneous Hartel approach, all of which resulted in masseter contraction. Patients who developed clinically significant pain improvement underwent implantation. The trigeminal ganglion stimulation permanent implants involved placing a grid electrode over Meckel’s cave via subtemporal craniotomy, which offered a greater ability to stimulate subdivisions of the trigeminal nerve, without muscular (V3) side effects. Two of the seven overall patients did not respond well to the trial and were not implanted. Five patients reported pain relief with up to 24-month follow-up. Several of the sphenopalatine ganglion stimulation patients had pain relief without any paresthesias. There were no electrode migrations or post-surgical complications.
Refractory facial pain may respond positively to ganglionic forms of stimulation. It appears safe and durable to implant electrodes in the pterygopalatine fossa via a lateral transpterygoid approach. Also, implantation of an electrode grid overlying Meckel’s cave appears to be a feasible alternative to the Hartel approach. Further investigation is needed to evaluate the usefulness of these approaches for various facial pain conditions.
Anesthesia dolorosa; Persistent idiopathic facial pain; Sphenopalatine ganglion; Trigeminal neuralgia
Peripheral neuromodulation for the treatment of refractory trigeminal neuralgia.
Trigeminal neuralgia is a type of orofacial pain that is diagnosed in 150,000 individuals each year, with an incidence of 12.6 per 100,000 person-years and a prevalence of 155 cases per 1,000,000 in the United States. Trigeminal neuralgia pain is characterized by sudden, severe, brief, stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, which can cause significant suffering for the affected patient population. In many patients, a combination of medication and interventional treatments can be therapeutic, but is not always successful. Peripheral nerve stimulation has gained popularity as a simple and effective neuromodulation technique for the treatment of many pain conditions, including chronic headache disorders. Specifically in trigeminal neuralgia, neurostimulation of the supraorbital and infraorbital nerves may serve to provide relief of neuropathic pain by targeting the distal nerves that supply sensation to the areas of the face where the pain attacks occur, producing a field of paresthesia within the peripheral distribution of pain through the creation of an electric field in the vicinity of the leads. The purpose of the present case report is to introduce a new, less-invasive interventional technique, and to describe the authors’ first experience with supraorbital and infraorbital neurostimulation therapy for the treatment of trigeminal neuralgia in a patient who had failed previous conservative management.
- [Indexed for MEDLINE]
Salvage treatment of trigeminal neuralgia by occipital nerve stimulation.
Although most patients suffering from trigeminal neuralgia (TN) respond to medical or surgical treatment, nonresponders remain in very severe painful condition.
We describe for the first time a case of severe refractory classical TN treated successfully (follow-up one year) by chronic bilateral occipital nerve stimulation (ONS), because other classic medical and surgical options failed or could not be performed.
This single case suggests that ONS might be offered to TN patients refractory both to standard drugs and interventions, with a favorable risk/benefit ratio, although its long-term efficacy remains unknown.
Trigeminal neuralgia; facial pain; neuromodulation; occipital nerve stimulation
- [Indexed for MEDLINE]
Ultrasound-guided trigeminal nerve block via the pterygopalatine fossa: an effective treatment for trigeminal neuralgia and atypical facial pain.
Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment.
To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions.
Academic pain management center.
Prospective case series.
Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa.
All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae.
Prospective case series.
We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions.
- [Indexed for MEDLINE]
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